Abstract
Background
The percentage of patients who leave the emergency department without being seen by
a provider is a measure of efficiency and presents risk-management concerns. The number
of patients actually “seen” by a provider is a measure of productivity. The opening
of our new emergency department in December 2012, resulted in increases in both demand
and the percentage of patients who left without being seen. Operational nursing leadership
managed ED patient flow, but the structure was loosely organized on an ad hoc basis.
Methods
Operational nursing leadership roles were re-assigned to personnel with management
aptitude and interest. The charge nurse coordinated care throughout all sections (pods)
of the department while the pod lead nurse coordinated care in each pod. The flow
coordinator nurse accepted transfers and emergency medical services arrivals. Nursing
and physician staffing remained unchanged, and measures were calculated over a 3-year
period (December 3, 2012, to December 2, 2015). The number of patients seen per day
was analyzed using simple linear regression. The percentage of patients who left without
being seen was analyzed using fractional logistic regression; P< 0.05 was considered statistically significant.
Results
The weekly mean number of patients seen per day rose 13% from 265 to 299 patients.
The weekly mean percentage of patients who left without being seen declined 45% from
8.2% to 4.5%. The regression lines for both measures were significant at P < 0.001.
Conclusion
Measures of efficiency and productivity can be improved significantly with a dedicated
operational nursing leadership structure without adding nursing or physician staffing.
Contribution to Emergency Nursing Practice
- •In the emergency department, the number of patients seen per day is a measure of productivity.
- •The percentage of patients who leave without being seen is a measure of efficiency.
- •Dedicated nursing management structure can improve productivity in the emergency department and the efficiency of flow.
Key words
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Biography
Niels K. Rathlev is Chair, Department of Emergency Medicine, Baystate Medical Center, Springfield MA
Biography
Jacqualyn Anderson, Member, Pioneer Valley ENA, is Director, Emergency Department, Baystate Medical Center, Springfield, MA.
Biography
Joseph Schmidt is Vice Chair, Emergency Department, Baystate Medical Center, Springfield, MA.
Biography
Joeli Hettler is Chief of Pediatric Emergency Medicine, Baystate Medical Center, Springfield, MA.
Biography
Lynn Garreffi, President, Pioneer Valley ENA Chapter, is Associate Director, Baystate Medical Center, Springfield, MA.
Biography
Molly Gray is Vice President, Baystate Medical Center, Springfield, MA.
Biography
Douglas Neal is Vice President, Baystate Medical Center, Springfield, MA.
Biography
Paul Visintainer is Vice-President for Academic Affairs, Baystate Medical Center, Springfield, MA.
Article info
Publication history
Published online: December 07, 2017
Footnotes
Earn Up To 7.0 Hours. See page 218.
Identification
Copyright
© 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
